The authors' purpose was to identify the relationship of disability to clinical measures that are part of a comprehensive psychiatric examination of depressed elderly patients.
The disability of 75 elderly inpatients and outpatients with major depression whose cognitive function ranged from normality to mild dementia was assessed with the Philadelphia Multilevel Assessment Instrument. Age at onset of depression, chronicity of depression, severity of depression, cognitive impairment, medical burden, social support and living environment were assessed with standardized instruments.
Impairment in instrumental activities of daily living was significantly associated with advanced age, severity of depression, and medical burden. The relationship of depressive symptoms to impairment in instrumental activities of daily living was not influenced by age or medical burden. Anxiety and depressive ideation as well as retardation and weight loss were significantly associated with impairment in instrumental activities of daily living. Interviewer-rated global disability was associated with advanced age at onset of depression, medical burden, and overall cognitive impairment. Specifically, a disturbance in initiation and perseveration was significantly related to global disability.
Impairment in instrumental activities of daily living appears to be a relatively independent dimension of health status that is related to depressive symptoms, particularly anxiety and depressive ideation as well as retardation and weight loss. Global disability may be associated with impairment in initiation and perseveration and with late onset of depression. These findings provide a basis for studies investigating whether psychotherapy aimed at depressive ideation and rehabilitation efforts focused on instrumental activities of daily living can improve the outcome of geriatric depression.
"In later life, age and depression may interact, resulting in a more pronounced retardation in geriatric patients. PMR occurs in atypical depression presentations in the elderly, such as subsyndromal depression  or depression-executive dysfunction syndrome . These motor abnormalities differed from slowing due to normal aging in that only some information-processing stages were affected by age whereas all the processing stages were affected by age . "
[Show abstract][Hide abstract] ABSTRACT: Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.
"Studying the effect of health conditions, among which characteristics of MDD and comorbid mental disorders, may therefore provide valuable information for the explanation of heterogeneity in disability with MDD (Fig. 1). Since persons suffering from MDD differ greatly in symptom characteristics, such as severity of depression (Spijker et al., 2004; Rytsälä et al., 2005), recurrence (Kruijshaar et al., 2003), and age of onset of depression (Alexopoulos et al., 1996), it is possible that individual characteristics of MDD and comorbid mental disorders account for the heterogeneity in disability. If this is the case, it is important to learn to what extent they do this, independently of the other characteristics. "
[Show abstract][Hide abstract] ABSTRACT: Although major depressive disorder (MDD) is associated with disability, some persons do function well despite their illness. Aim of the present study was to examine the effect of illness characteristics and comorbid mental disorders on various aspects of disability among persons with a current MDD episode.
Data were derived from 607 participants with a current MDD based on the Composite International Diagnostic Interview (CIDI). Severity was assessed via the Inventory of Depressive Symptoms self-report (IDS-SR). For disability three outcome measures were used: World Health Organization Disability Assessment Schedule II (WHODAS) disability and its 7 dimensions, days out of role, and work absence. Using multiple regression analysis the effects of MDD characteristics and comorbid mental disorders were estimated.
The IDS-SR score was the best predictor of all disability outcomes. Of the comorbid mental disorders, agoraphobia was significantly associated with overall disability. Collectively, all illness characteristics accounted for 43% of variance in WHODAS disability, 13% in days out of role and 10% in work absence, suggesting substantial unexplained variance.
Only self-report measures of disability were used. There were no assessments of other diagnoses than depressive, anxiety and alcohol use disorders.
Although heterogeneity in disability of persons with current MDD is partially explained by illness characteristics of MDD (especially symptom severity) and comorbid mental disorders, most of the variance is not accounted for.
"Disability in the form of an increased risk of falls is associated with depression in later life.62,63 Severity of depression, degree of CI, and medical burden explain less than 40% of the variance in disability, implying that disability is a broader dimension of health status than each of these factors alone.51 "
[Show abstract][Hide abstract] ABSTRACT: Less than half of older adults with depression achieve remission with antidepressant medications, and rates of remission are even poorer for those with comorbid conditions. Psychosocial interventions have been effective in treating geriatric depression, either alone or better yet, in combination with antidepressant medications. Traditional strategies for nonpharmacological treatment of late-life depression do not specifically address the co-occurring cognitive impairment and disability that is prevalent in this population. Newer therapies are recognizing the need to simultaneously direct treatment efforts in late-life depression towards the triad of depressive symptoms, cognitive dysfunction, and functional disability that is so often found in geriatric depression, and this comprehensive approach holds promise for improved treatment outcomes.
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